A recent post on a facebook discussion group asked a great question: how do we reduce or eliminate secondary characteristics for children who stutter?
Addressing secondary characteristics is a common desire for speech-language pathologists, teachers, and family members alike, but I’d like to offer a different way of looking at how we might achieve this goal. Specifically, it's not actually necessary in most cases to address secondary characteristics in their own right. Typically, these behaviors arise from the child’s attempt to avoid or postpone or prevent stuttering from occurring, or from his attempts to regain control during or after a moment of stuttering. The underlying cause of the struggle and secondary behaviors, then, is the child’s attempt to not stutter. (Johnson said it years ago… paraphrasing, “Stuttering is what the speaker does in his attempt to not stutter.”) All of that need to not stutter stems from the underlying discomfort with stuttering—the fear, embarrassment, shame, etc. that make stuttering so uncomfortable for speakers.
What this means is that the child will continue to exhibit secondary characteristics in one form or another for as long as he is uncomfortable with stuttering. Sure, you can eliminate one behavior (eye blinks, for example, or tensing the extremities), but if the child is still struggling to not stutter, then that struggle will erupt in some other behavior. You end up in a constant cycle of chasing down one secondary characteristic only to have another one spring up because the source of the problem is remains—that is, the child’s inherent fear of stuttering.
Here’s an excerpt on secondary behaviors from School-Age Stuttering Therapy: A Practical Guide (Reardon-Reeves & Yaruss, 2013, p. 271) drawn from one of our handouts for explaining stuttering to teachers:
“When children who stutter increase tension or “push” to get words out, they may begin to push harder and harder, building tension in their facial muscles or other muscles of the body. These children are not moving other parts of their body on purpose; they are simply trying anything they can think of to try to get their words out. Sometimes it seems that pushing helps a child talk more fluently, but most of the time, the excess tension actually contributes to the overall communication problem. As children learn to tolerate moments of stuttering, and as they find themselves in increasingly accepting environments, they usually find that they can struggle less with their speech and, ultimately, stutter more easily, in a manner that is less disruptive to their communication.”
Finally, as for goals: Because the secondary characteristics stem from the child’s fear of stuttering, what we really want to accomplish here is to reduce the fear of stuttering. This can be addressed through a series of objectives that help the child learn about his speaking mechanism, about stuttering, and about what he does when he stutters. Next we move to the all-important lesson that he can make changes to how he stutters. With this foundation solidly in place, we can then move toward acceptance and desensitization work that helps the child learn that it is okay to stutter. The more he knows that it is okay to stutter, the less likely he is to struggle with moments of stuttering when they occur. We can combine this with work on stuttering modification strategies (including easier voluntary stuttering or pseudostuttering) to help him practice stuttering with less physical tension and struggle (or with less secondary behaviors). The goal here is not just to stutter less (we’ll work on that more later); it’s to help him stutter more easily so his stuttering is less uncomfortable for him and less disruptive to his communication overall. (Sample wording for these types of goals is in School-Age Stuttering Therapy: A Practical Guide, Chapter 12.)
Of course, there’s much more to say, but this just a blog post, after all…